Computers and
attendant software are tools, used as a means to an
end. The number one reason to use an EMR is "Communication."
Communication isn’t the only thing, it is
everything. This is especially true in the health
field, where life and death, sickness and health,
can be contingent on communication or lack of it.
Whether in the emergency room of a hospital, or a
simple patient encounter in the office,
communication is paramount.

Over the past few years, three significant Federal
Mandates have been issued regarding adoption of
electronic medical records (EMR).
This will drastically change how you practice and
sooner than you think!

"And Fifth, we can control health care costs and improve
care by moving American medicine into the information
age. My Budget for the coming year proposes doubling to
$100 million the money we spend on projects that use
promising health information technology. This would
encourage the replacement of handwritten charts and
scattered medical files with a unified system of
computerized records. By taking this action, we
would improve care, and help prevent dangerous medical
errors, saving both lives and money."

February 20, 2008

Voters Want a President
Who Would Back a Health IT Network

Seventy percent of U.S. voters
said they would be more likely to vote for a
presidential candidate who supports the creation of
a Nationwide Health Information Network, according
to a recent survey commissioned by Computer
Sciences, Government Technology
reports.

December 8, 2008:
U.S. President-elect Barack Obama has outlined an
ambitious plan to give every child in the U.S. access to
the Internet and to connect the nation's hospitals with
"cutting edge technology.

"We will make sure that every doctor's office and
hospital in this country is using cutting edge
technology and electronic medical records so that we can
cut red tape, prevent medical mistakes, and help save
billions of dollars each year," he said.

In my humble opinion, the TabletPC is the most expedient
conduit for the application of such records and here is
why:

Prelude:

I would venture to say, that there is nothing that
a physician presently does with pen and paper,
that could not be
done more
expediently on a Tabletpc. You can make template
documents to be used on all your patients, like you do
now with your exam and intake forms. You can write Rx
scripts from Journal, and print to a networked/shared
printer via wifi or even IR.
Evernote ,
OneNote and GoBinder are robust applications that
allow inking, voice and organization. A custom EMR can
be made with any of these programs. Better yet, here is
an EMR to get you started
www.abletfactory.com.
You can read about Abletfactory on
MedicalTabletPC.com.

A doctor could
use a scanner to input existing documents into the
Tabletpc,
that are
presently used as paper.
In other words, scan in the paperwork that you already
use and now use the same paper work on your TabletPC.
Alternatively, if documents
are in Word format, you can use them on
a Tabletpc or port them into Journal which would
allow the user
to write on top of the document like with a pen and
paper. If you can find a quiet environment, you can
dictate into your TPC. You can be wirelessly online with
Wifi, and bookmark educational material for your
patients that can be printed out at the point of care.
You have the potential to network with other computers
and send and receive information over the LAN or via
email, if no LAN. (Labs could be emailed). With prudent
backups, you will be shuffling pages with a stylus in
nanoseconds instead of paper shuffling in a messy file.
You can chart at the point of care and be
finished at the point of care.

Introduction:

What is EMR? EMR
(electronic medical records) refers to a category of
software products designed for the healthcare industry.
There was a time when every patient encounter, every
chart, every prescription, every bill, every aspect of
managing a practice, was accomplished manually. The
choice isn't whether to convert your practice to EMR,
it's simply when. And which EMR to buy...
Click here for an Flash Conference on EHR 101.

Ideally, your practice will be best served by a
robust EMR program.
The main goals of any EMR system should be to enhance
production and facilitate the quality of care. The two
most important features are simplicity of using
the program and input speed, at the point of
care. Beyond that, the program should be shared
with doctor and staff and no one should be intimidated
by the complexities of the system. In addition, the
solution should offer flexibility and custom
features, so that everyone feels comfortable not only
with the technical aspects of the program, but also the
way in which documents are created. The doctor should be
able to customize the program to reflect the way they
practice and not have the software program dictate
practice protocol. Doctors have learned to take care of
patients in a certain way, and the software and computer
has to fit into the work flow, not be perceived as extra
work, and not interfere with the doctor-patient
interaction. Another mandated feature is physical
portability, resulting in, at the point of care
documentation. This equates to avoiding subsequent time,
often after office hours, reviewing and updating records
on your PC or chart. Ultimately, the software and
hardware, must be able to facilitate communication
and save time—that’s the key.
50 Reasons to get an EMR from Medical Economics.

Historically, the
chart has been a repository of paper. An EMR system is a
patient information network as well as an office
management tool. Used as the primary source for patient
records, it is a modern medical chart with the same
structure, scope and information as a paper-based
record. The chart
is filled with details about the patient and their care.
The power of an EMR Chart is in the data it holds, but
even more important, is the ability to retrieve data
back out or extract it visibly and or print it out for a
third party. There can be volumes of information in a
given chart, but the doctor may only want to see one
specific part. A good EMR has the equivalent of flip
switches or filters, which allow the viewer to see only
what is applicable and or desired. All information
needs to be available, but not in your face all the
time. The quick access to and retrieval of information
are what doctors consider most impressive. Retrieving
and viewing data by date or visit are simple and
straightforward when the user interfaces are properly
designed.It
enables immediate access to information.

Goals:

Computer-based patient records can remedy the inherent
flaws of the conventional paper system through the
improvements in accessibility, cost savings, quality,
and marketability.

EMR systems create cost-effectiveness within a budget by
virtually eliminating dictation and transcription costs,
thereby avoiding thousands of dollars in transcription
fees. With transcribers out of the picture and with the
ease of data entry, fewer personnel are needed. Data
entry time may be halved, so fewer people are required
to work.

An EMR system minimizes mistakes.
There is no need to decipher bad script because
completely legible records are produced. Information
will never be lost, (backup) no duplicate testing
ordered, nor any unnecessary repeat treatment offered.

Not all users will
"realize" the immediate value of an EMR. In fact,
in a hectic and hurried setting the value is lost when
compared to paper, at least if don't extrapolate beyond
the present. A palpable value is when the patient
returns and you don't have to thumb through all those
pages in a paper chart. The tangible value is in Data
Mining or having all the data in one place and being
able to visibly extract or filter the data which is
desired, in a rapid and expedient manner. With respect
to third party payers, the value consists of being able
to manipulate, retrieve and output the data collected,
ideally at the point of care.

An EMR system improves communication by making records
available to multiple people, simultaneously. Switching
to an EMR system can save a doctor hours, which would
otherwise have been spent updating patient files. All
charts are kept current and provide more detailed
patient information than paper-based records. A doctor’s
extra time benefits patients. Less time is spent waiting
and more quality time is available for patient care.
Productivity also increases as the practice becomes more
streamlined. With a well-managed practice, a provider
may increase the patient base because better treatment
is provided. Charting can be completed at the point of
care and not after hours!

Tabletpc versus
PDA:

Desktop machines lack portability. Palm and PocketPC
platforms are fine for reference material, but too small
and underpowered for EMR. The
PDA OS, both Palm and PPC are both too slow and the
physical dimensions don't allow enough visual real
estate. Scrolling from screen to screen is time
consuming and captures only snippets of information. In
addition, to do anything meaningful (see the entire
note, robust reports), the program has to upload to a
Desktop PC where the data is manipulated. Why not cut
out the middle man and do it all on one bigger
device........the Tabletpc? For me, a
TabletPC is better than a Desktop PC, a
PocketPC (PPC), or any Handheld PC, at least for EMR,
simply because it is a mobile, yet robust communicating
tool, with the caveat that it does not fit in your
pocket.
As a long time PDA user, that is a genuine
compromise for me. For better or worse, it is all about
compromise.
The TabletPC demonstrates critical
"visual real-estate," and is readily network able
with other LAN PCs. Real time voice dictation is built
in to the OS as well as handwriting recognition in
various forms from Journal to Write Anywhere to Tablet
Input Panel. Whatever you can do with a pen and paper or
a desktop PC, you can do with a Tabletpc! Forget
navigating horizontally, vertically and diagonally with
a mouse; move directly and intuitively to the target
with a stylus/pen! Additionally, when networked, other
staff can input data besides yourself, in "real time,"
enabling a Triage Approach to patient care. For example,
a historian can prepare the history and ROS, the front
desk the demographics, a nurse the vitals, all prior to
the doctor examining the patient. Then, the doctor
digitizes the exam findings and chart note. (IMO, this
is best started with a protocol template that is easily
customizable, rapidly inserted and easy to change with
hyperlinks to exam findings/tests and appropriate drop
down list boxes, etc.

I am partial to an EMR that has the option to uses color
coded,
sophisticated XML hyperlinks to make customized,
editable, changes. What this amounts to is the doctor
reads the typed soap note and the clicks on
only the portions that need change. This means a
user can rapidly make changes by clicking on hyperlinked
text e.g.. A male patient of 50, presents with neck
pain that is moderate and constant.......
In this simple scenario when you click on the underlined
text, a list box pops up with custom answers that are
changeable and reflected in the soap note. The notes
reflect a "What you see is what you get" philosophy
(WYSIWYG). All of the exam charting is done from one
screen. There is no need to switch between screen to
enter each section of information. The note is laid out
as you write it. All information is readily viewable,
obviating the need to scroll, pan and or change screens
as on a Personal Digital Assistant (PDA). Of paramount
importance, the entire chart note (SOAP) is visible for
review, on a single screen, an important factor in a
harried and hurried setting.

For patient education, the larger viewing area is
obviously better than a PDA's 3.5" screen, and when
wirelessly connected to the internet with DSL, you have
a very potent mobile educational tool, where screen
shots and patient hand outs are easily printed from the
point of care, to a network printer. Point of care
communication with the entire networked staff is easily
accomplished with "robust office applications," not
feasible on a PDA.

With respect to an EMR,
I think the PDA will forever be relegated to a good
"reference tool," and at best, be an adjunct device to a
good EMR package that is, " hardware independent." In
other words, depending on your specialty and needs, a
user could use a PDA in conjunction with a
Desktop or Tabletpc application, but using a PDA alone,
as an EMR, is arguably not viable.

Summary Conclusion:
Paper versus Digital

With the proper EMR, the entire chart is "in your face,"
and all aspects of patient care are each a single click
away. With a sophisticated EMR, the entire soap note is
on a single page, immediately presented to the viewer.
It doesn't get much faster and easier and it is
certainly quicker than paging thru and reading an inch
thick unorganized paper chart. Any and all data can
populate a custom document for paper communication when
needed. A good EMR has the potential to reduce
documentation time, ensure coding accuracy and
appropriate reimbursement, avoid down coding,
detect medication contraindications, reduce
liability, enhance patient care, regain
control of your time, spend quality time
practicing.

Databases: All
EMRs need to centralize on a database where data can be
shared with providers and hospitals. Medicine must
create value with improved efficiency through electronic
medical records. This will improve evidenced based
standards and only serve to advance health care.